General Information about your treatment - PowerPoint Presentation

1. General Information about your treatment Centre for Reproductive Medicine University Hospitals Coventry and Warwickshire NHS Trust Clifford Bridge Road Coventry CV2 2DX 024 76968879

2. ContentsWelcome to the unit   What is this leaflet for?An introduction to our clinicUnderstanding HFEA Code of Practice  and confidentiality Getting started  Referral process and pathwayPreconceptual care Pre-treatment requirements  What treatments that are available IVF/ICSI IUI  OI  Additional treatments   Three tier funding Our Success rates CRM Research Support Support counselling  Implications Counselling Supporting men Other things to consider FeedbackComplaints procedureUseful websites Contact Numbers

3. What is this leaflet about and who it is for? This leaflet has been designed to provide you with all of the information about your upcoming treatment journey with CRM. After reading this you will hopefully know what to expect before, during and after your treatment. The patient journey will differ according to which treatment you are having. The Centre for Reproductive Medicine Coventry is licenced by the Human Fertilisation and Embryology Authority (HFEA) and also has a certified ISO accredited Quality Management System to ensure that our quality standards meet the requirement and regulations set by the HFEA. What treatments can you have at The CRM?Our centre offers lots of different treatment options, those of which are recommended for you will be offered during your follow up consultation. We offer monitoring/tracking of menstrual cycles as well as assisted conception treatments. Assisted conception includes all treatment in which gametes (sperm or eggs) and/or embryos are handled outside the body (in the laboratory). Assisted conception treatment includes intrauterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), sperm or egg freezing and embryo freezing.

4. A little more about us …Our clinic is run by a highly skilled multi-disciplinary team who bring vast experience and expertise to the field of Reproductive Medicine. Please note this is a teaching hospital and the presence of students is possible. We are recognised for our excellent Scientist Training Programme (STP) and to assist our trainees you may be asked to consent to using your gametes or embryos for training. We also run monthly combined clinics with specialists such as Male factor clinics with specialists in Urology, Endocrinology, Dietetics and Recurrent Miscarriage Clinics. We have links with our colleagues in Obstetrics and Gynaecology and the Early Pregnancy Unit. We can also refer you to laboratory specialists such as genetics or haematology. Our promise to you .. Our mission is to provide the best possible evidence-based care to all our patients and support you on this journey. Our dedicated team are with you every step of the way.

5. HFEA Code of Practice & ConfidentialityDuring your visits to CRM, you will be given lots of information both verbally and written. Sometimes it can be difficult to remember all of information given to you. Before you commence treatment it is important that you understand the points below:You will sign initial consents during your first visit. These include a consent to disclosing your information, a welfare of the unborn child assessment, a travel questionnaire. You will also be asked to declare information on your residency status in the UK All patients have access to Fertility Counselling. A service that is free of charge and you can benefit from before, during or after treatment The impact of treatment on your domestic life and costs implications of treatments and medications The individual success rates of your recommended treatment, other possible outcomes and how effectiveness can vary.- The associated risks with assisted conception such as Ovarian hyperstimulation Syndrome (OHSS). The techniques involved in treatment and the possible pain or discomfort you might feel- Our single embryo transfer policy to avoid multiple pregnancies -The centres policy on selection of patients- The options of storing gametes and embryo and freezing and thaw rates - as well as current storage laws- The importance of telling us the outcome of any birth - In egg donation, the screening of donor and the infection risk of recipient- Your right to withdraw consent - The information which the CRM must collect and register with the HFEA and the extent to which that information may be disclosed.

6. Patient PathwayGP Referral to the clinicInitial consultation and investigationsFollow upPre- treatment information session Further investigations Hycosy Start Ovulation induction

7. Your pathway explained GP Referral All patients are required to have a GP referral prior to starting their journey with us regardless if you are NHS, Self funded or Private. Your GP will refer online and you will get an initial appointment in the post. Initial Consultation and investigations Please arrive in person for your first appointment as you will be required to complete a comprehensive history and consent forms prior to seeing the Doctor. If you are being referred as a couple, ensure you both attend.Please arrive 10 minutes before your appointment. You will also be required to have a weight check and both partners (if applicable) will be asked for a sample of breath to confirm smoking status. You will then be referred to the Specialist nurse for some initial investigations which include a transvaginal scan, vaginal swabs and blood tests. If you have a male partner he will also be asked to book a semen analysis appointment, this will be done on another day and results given during your follow up appointment Hycosy As part of your initial investigations, you may have been referred for a Hycosy procedure. This appointment will be sent to you in the post along with an information leaflet. It is important you read the Do’s and Don'ts on the reverse before attending your appointment. Please note that a Hycosy procedure is not necessary if you are having IVF.Follow upOnce you have completed your investigations, you will receive a follow up appointment in the post. This appointment is generally on the telephone. If you prefer, you can come to the clinic. During this appointment, the Doctor will discuss the results and recommended treatment options for you.

8. Pre-conceptual careIf applicable to you, you will be advised on the following pre-conception advice prior to treatment Folic acid/Vitamin D Other alternative supplements recommended for youMaintaining a healthy diet and lifestyle Optimizing BMI – weight management Smoking Alcohol Stress management Exercise Travelling Advice on pre-existing conditions such as hypertension, diabetes and asthmaGenetic diseases and their implications Cervical Smear testing

9. Pre-treatment requirementsYou will need to have your Rubella immunity checked before treatment. If you are not immune to Rubella you will be advised to contact your GP to be vaccinated against Rubella and then have the test repeated after one month to confirm that you have become immune prior to treatment. It is also important to screen patients for any vaginal infections such a chlamydia prior to treatment. You will also be screened for abnormal haemoglobin (sickle cell and thalassemia). If results are not within the normal range, your partner will be screened for abnormal haemoglobin. If both have results which are not in normal range, you will be referred to a Haematologist.Prior to starting assisted conception treatment, you and your partner will need to have a blood test to screen for HIV, Hepatitis B and Hepatitis C. This is essential as we need to take extra precautions when dealing with sperm, eggs or embryos from carriers of those conditions. The above health screening is clinic policy for infection prevention and welfare of the child considerations. This means that patients and partners will be required to undergo screening, even if they are not providing gametes such as a Frozen Embryo cycle These will be checked at your pre-treatment information session.

10. Treatment available at CRMWe offer a comprehensive and growing range of diagnostic and treatment services listed below Andrology servicesSemen analysis, Sperm DNA Fragmentation, Zika Virus testing, retrograde analysis , post vasectomy analysis.Fertility Preservation Preserving eggs, sperm and embryos prior to compromising treatment such as cancer treatment. Also social egg freezing is available if you are aged 35 or younger.Egg DonationEgg donation is a process in which one woman donates her eggs to help another woman who is unable to produce her own eggs. Donors may be a relative or a friend known to the recipient receiving the eggs, or can be an altruistic anonymous donor. Because altruistic egg donor recruitment is difficult, waiting lists for this form of treatment are often prolonged to several years unless the patient is able to find a donor herself.Egg Share programme Egg Sharing is a process in which a woman (the sharer or donor or provider) going through IVF treatment (because she needs IVF to get pregnant), elects to give away (donate) half of her eggs to another woman who needs donor eggs because the recipient woman is unable to produce her own. By doing so the egg provider not only helps somebody to become pregnant, but she gets her own IVF treatment at a substantially reduced cost.Frozen Embryo replacement Frozen embryo transfer (FET) also known as frozen embryo replacement (FER), consists of the thawing of embryos which were frozen during previous IVF or related treatment, and the replacing of them in the uterine cavity at the appropriate time of the menstrual cycle.

11. .ICSIICSI has revolutionised the treatment of male infertility, offering assistance to couples who previously were unable to have a baby whose father was the genetic parent.With ICSI, very few sperm are required and the ability of the sperm to penetrate the egg is no longer important as this penetration is bypassed by the injection technique.IUIIUI involves the introduction (insemination) of sperm from the husband, partner or donor into the woman's womb via the neck of the womb. The insemination is generally a painless procedure which takes only a few minutes and is performed on an outpatient basis. The chances of success are increased if the insemination is combined with ovarian stimulation using small doses of fertility drugs.IVFIVF is fertilisation outside of the body. It involves the stimulation and extraction of eggs, then the mixing with sperm either partner or Donor and then the replacement of a fertilised egg, an embryo into the womb.Ovulation induction If a patient is not ovulating on their own, ovulation induction may be recommended. It involves taking some medication, scans for follicular monitoring and timed intercourse Surgical Sperm Retrieval Surgical sperm retrieval may be a treatment option for men with: An obstruction preventing sperm release, due to injury or infection. Congenital absence of the vas deferens (men born without the tube that drains the sperm from the testicle), Vasectomy or Non-obstructive azoospermia. Tubal surgery This is an operation requiring general anaesthetic to correct situations where the sperm/egg transport mechanism through the tubes is disturbed known as "tubal infertility". Such operations are done to repair a blocked or damaged fallopian tube, or to divide adhesions or remove lumps in the pelvis which may be distorting or interfering with the course of the tube.

12. Funding NHS Funding Unfortunately, not all treatment provided is funded by the NHS. The provision of NHS funded fertility treatment is limited, and you need to meet the criteria set by the Integrated Care Boards (ICB). The ICB decide the eligibility criteria and it is not set by the centre.CRM accept referrals from many ICBs and so criteria varies. This can be discussed with you at your appointment. As the majority of our patients are referred from Coventry and Warwickshire, an outline of the criteria is listed below however, please be aware this may change:1 year of unprotected sexual intercourse (where this definition cannot be applied, for example females in a same sex relationship, those who find it difficult to have vaginal intercourse or trans-gender male patients, infertility is defined if there is no conception after 6 cycles of self-funded donor or partner insemination undertaken at a HFEA registered clinic in the absence of any known medical cause of infertility). Childlessness – treatment will only be available where neither partner has a living or adopted child of any age. Sterilisation – treatment will not be available if infertility is the result of a sterilisation procedure in either partner.Previous infertility treatment – any couple who has had one or more previous NHS funded cycle or three or more privately funded cycles will not be eligible.Age of maternal partner – treatment will be offered where the maternal partner is under 40 years at the time of referral.Age of non-maternal partner – there is no restriction to the age of the non-maternal partner.Body mass index – treatment will not be provided where the maternal partner has a BMI of < 19 kg/m2 or > 30 kg/m2.Smoking status – it is expected that couples accepted for treatment would be non-smoking.  Smoking should have stopped for at least 4 weeks prior to referral and refrain from smoking throughout the treatment process. One cycle of treatment is normally funded along with up to two frozen embryo replacements if additional embryos are available for freezing. 

13. Funding Fertility preservation Funding from Coventry and Warwickshire ICB is also available for cryopreservation of gametes and embryos in the following circumstances: Patient is undergoing NHS funded medical or surgical treatment which is likely to lead to infertilityPatients having medical or surgical treatment for cancerPatient is at high risk of premature ovarian insufficiency (defined as amenorrhoea of at least 12 months, hormonal profile in the menopausal range, under the age of 40). Cryopreservation is not available for any other patient group (e.g. embarking on a private pathway of care or to delay conception for non-medical reasons).   Approval for funding does not guarantee funding for future assisted conception treatment.  Patients must meet the following criteria: Must be permanently registered with a Coventry/Warwickshire GP practiceIf female- must be of reproductive age.If male – must have reached or undergone adolescence. Cryopreservation is funded for up to 10 years.  Social Egg freezing is available for patients under the age of 35 and would be self-funded.

14. Funding Self-funded treatment If you don’t meet the criteria set by the ICB, but you meet the self funded criteria set by CRM, you can proceed with treatment on a self-funded basis. Please see our website for treatment costsPrivate Pathway Whether you are NHS funded or Self funded you have the option to have consultant led care for your treatment. OverseasIf you are visiting the United Kingdom (UK) or you are not an ordinary UK resident and require treatment in our hospitals, you may have to pay for your appointments, investigations and treatment. Please contact the Overseas team to confirm eligibility.

15. Our success ratesOur success rates for treating infertility have consistently proved to be among the highest in the UK even allowing for the fact that our Centre accepts all couples and often the most difficult cases. However, it is important to be mindful of the fact that success rate may vary because of a variety of individual factors, which may increase or decrease your likelihood of you having a baby.You can find our most recent success rate on our website below.The results are split into age categories (as this will affect the chances of the treatment working) and also refer to the total of number of cycles carried out. This includes any patients whose ovaries were stimulated to attempt to produce eggs. The results that state “per embryo transfer” only include patients who reached the stage of having an embryo(s) to replace. https://www.uhcw.nhs.uk/ivf/results/

16. CRM Research We currently have a dedicated team of Researchers here at CRM who support patients through a range of exciting ongoing clinical trials that are happening. We currently have trials ongoing for different areas of infertility such as Endometriosis, PCOS, Comparing Gonadotrophins with ovarian response , please see our Research notice board in the waiting room for up-to-date studies. We offer embryoscope monitoring for IVF/ICSI cycles. The embryoscope is a specially designed incubator that takes computer pictures of each embryo while it is in the laboratory. These pictures, taken approximately every 10 minutes, give embryologists very detailed information about what the embryo looks like as it grows, precisely when certain events in development take place, and can reveal many small but important changes that would otherwise be missed. Women at risk of reproductive failure, including recurrent miscarriage and complications in pregnancy are seen in dedicated consultant-led research clinics before pregnancy.Please contact crmresearch@uhcw.nhs.uk for more information

17. SupportThe decision to have a child is a life changing one for any individual or couple. Whether the difficulties in conceiving have been anticipated, or are encountered only when a couple start trying to conceive, there is a sense of loss which each person experiences and copes with in their own way.Counselling - Email uhcwfcs@uhcw.nhs.ukCounselling can give you the time and space to explore and share your thoughts and feelings. Counselling gives you the opportunity to work through the feelings you are experiencing, to discuss any issues that have arisen and to look at other ways of moving forward.For those who are considering treatment that includes the use of donated sperm, eggs or embryos, it is a requirement that anyone wishing to donate or to use donated sperm, eggs or embryos must attend implications counselling. This is also the case for those wishing to pursue surrogacy.Fertility Support groupOur counsellors also work in collaboration with the Department of spiritual Care to run a monthly support group for individuals or couples at any stage in their treatment.Male Fertility Support - Email male.fertility@uhcw.nhs.ukOur dedicated male fertility support address that is manned by our andrologist provides support for men before, during or after their treatment. Post Treatment SupportAll patients that have assisted conception treatment will have a post-treatment support call by a Fertility Nurse after the outcome of their treatment, regardless if the treatment has been successful or not. This is an opportunity to discuss your next steps of treatment

18. ConsiderationsPlease note that CRM is unable to guarantee that your treatment will be carried out by a specific doctor or nurse. Please let us know if you would not proceed with treatment unless a specific doctor or nurse is available. Accessibility Our clinic is accessible for patients with a disability. Please let us know ahead of your appointment if you require any additional support with your mobility. Prayer room The UHCW Trust has a multi faith prayer room available for use, as well as chaplains who represent numerous faiths Translation Services We are able to provide translators in a number of different languages. Please ask for details. Written and verbal information is also available in several languages. Treatment leaflets Leaflets are available in more detail for all our treatments. Website We have a comprehensive website which gives more details about all our services and staff.www.uhcw.nhs.uk/ivf

19. How did we do?We are grateful for all feedback positive or negative, as it means we can better understand what is important for our patients. Should you want to give special thanks for an individual who you feel went above and beyond with your car, you can nominate them for a world class colleague award found on the trust website www.uhcw.nhs.uk If you feel that your expectations of your treatment journey have not been met, you have the right to share your feedback. Please be informed that if you do make a complaint, your subsequent treatment will in no way be prejudiced. Contact PalsYou can submit a complaint to the Patient Advice liaison Service (PALS) by emailing feedback@uhcw.nhs.uk or telephone 08000284203If your complaint is regarding the car parking, please send an email to visitor.parking@uk.issworld.com

20. Useful websites and additional SupportHUMAN FERTILISATION & EMBRYOLOGY AUTHORITY (HFEA)2nd Floor, 2 Redman Place, London, E20 1JQTel: 020 7291 8200www.hfea.gov.ukEmail us: enquiriesteam@hfea.gov.ukENDOMETRIOSIS UK10-18 Union StreetLondonSE1 1SZTel: 0808 808 2227 / 020 7222 2781www.endometriosis-uk.orgTWINS TRUSTHelpline Twinline: 0800 138 0509www.twinstrust.orgDONOR CONCEPTION NETWORK154 Caledonian RoadLondonN1 9RD Tel:0207 278 2608enquiries@dcnetwork.orgwww.dcnetwork.org

21. Other websitesCOTS (Childlessness Overcome Through Surrogacy)Foxy House41 Fox Hill RoadGuilden MordenSouth CambridgeshireSG8 0JHTel: 0333 772 1549kim@surrogacy.org.ukwww.surrogacy.org.ukOther supportive networks SANDS –Supporting bereaved families after loss. Mermaids – A charity that supports young gender diverse people and their families

22. Contact Numbers Clinic Area Contact Number Reception (Appointments/General enquiries) Mon-Fri and answerphone available. Please note it is not manned on Sat/SunNurses Helpline(Answerphone available and all messages will be responded to by the end of the day)Embryology (Answerphone available)Semen analysis (Appointments only, please note we cannot give results over the phone) Funding Queries Donor Sperm (Paula)Egg donation (Specialist nurse Louise)Secretaries (Access to your records, Referrals, letters or waiting times for surgery)Emergency Out of hours (Ward 23 Gynaecology Ward) Overseas Department Research and EmbryoscopeCounselling Fertility Preservation02476 96887902476 968856crmnurses@uhcw.nhs.uk02476 96887602476 968873crmfundingqueries@uhcw.nhs.uk02476 968887 crmdonorsperm@uhcw.nhs.uk02476 968856024 7696 7409 / 024 7696 7381crm@uhw.nhs.uk02476967000overseaspatients@uhcw.nhs.uk crmresearch@uhcw.nhs.ukEmbryoscope@uhcw.nhs.uk02476968886uhcfcs@uhcw.nhs.ukFertilityPreservationCrm@uhcw.nhs.uk

23. Questions If you have any questions, write them down here to remind you to ask the team during your next appointment ……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….……………………………………………………………………………………………………….